0001235802-17-000157.txt : 20171006 0001235802-17-000157.hdr.sgml : 20171006 20171006164309 ACCESSION NUMBER: 0001235802-17-000157 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20171004 FILED AS OF DATE: 20171006 DATE AS OF CHANGE: 20171006 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: PETRICK TIMOTHY B CENTRAL INDEX KEY: 0001625443 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36814 FILM NUMBER: 171127863 MAIL ADDRESS: STREET 1: C/O ENTELLUS MEDICAL, INC. STREET 2: 3600 HOLLY LANE NORTH, SUITE 40 CITY: PLYMOUTH STATE: MN ZIP: 55447 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: ENTELLUS MEDICAL INC CENTRAL INDEX KEY: 0001374128 STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841] IRS NUMBER: 204627978 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 3600 HOLLY LANE NORTH STREET 2: SUITE 40 CITY: PLYMOUTH STATE: MN ZIP: 55447 BUSINESS PHONE: 763-463-1595 MAIL ADDRESS: STREET 1: 3600 HOLLY LANE NORTH STREET 2: SUITE 40 CITY: PLYMOUTH STATE: MN ZIP: 55447 4 1 primary_doc.xml PRIMARY DOCUMENT X0306 4 2017-10-04 0 0001374128 ENTELLUS MEDICAL INC ENTL 0001625443 PETRICK TIMOTHY B C/O ENTELLUS MEDICAL, INC. 3600 HOLLY LANE NORTH, SUITE 40 PLYMOUTH MN 55447 0 1 0 0 VP, Research & Development Common Stock, $0.001 par value 2017-10-04 4 S 0 2000 20.013 D 92385 D These shares were sold under a pre-arranged sales instruction pursuant to Rule 10b5-1 under the Securities Exchange Act of 1934, as amended. The price reported in Column 4 is a weighted average price. These shares were sold in multiple transactions at prices ranging from $20.00 to $20.05, inclusive. The reporting person undertakes to provide to Entellus Medical, Inc., any security holder of Entellus Medical, Inc., or the staff of the Securities and Exchange Commission, upon request, full information regarding the number of shares sold at each separate price within the ranges set forth in this footnote (2) to this Form 4. Includes an aggregate of 933 shares acquired under the Entellus Medical, Inc. 2015 Employee Stock Purchase Plan on June 30, 2016, December 31, 2016 and June 30, 2017. /s/ Brent Moen, attorney-in-fact 2017-10-06